Fermion
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Many opponents firmly believe that this law is disastrous for America and think anything that will undermine it such that it can eventually be overturned is a valid response. Thus the refusal by multiple states to accept the Medicaid expansion despite that fact that the Fed picks up the full tab now, 90% later. Those states punish their own poor while helping to pay the bill for the other states that that do accept Medicaid all in an effort (maybe a principled effort) to undermine and kill off the ACA. The DC Circuit decision gives those same states a much greater tool to undermine the law. They will take it. I haven't seen any evidence that opponents are willing to join in efforts to modify the ACA to improve it. I suspect that would only happen if, after many years, it becomes clear that nothing will work to kill it entirely.
People will start to vote with their feet, eroding the tax base of states who choose not to participate in ACA and get the federal benefits. One by one these states will cave as they see big budget gaps.